feasibility of a purpose in life renewal intervention for adults with persistent symptoms after concussion

Conditions: Concussion; Syndrome

Summary: a group of clinicians and researchers developed an 8-session group intervention that integrates education, support, self-reflection, and action-expectation to help people reaffirm or reconstruct self-grounded purpose after significant life events/transitions. the 8 sessions extend over 2-3 months, with 7 weekly sessions and the final session 1 month after session 7. the intervention, called the compass course is structured around the 6 dimensions of flourishing (autonomy, self-acceptance, personal growth, relationships, purpose in life, external mastery), the goal of which is to help people enact behaviors that move them forward in reframing a sense of self and reaffirming or reconstructing a sense of purpose in their daily lives. participating in this research will involve an introduction session, where informed consent will be obtained, followed by the 8-session intervention for 9 sessions in total. a team composed of researchers from courage kenny rehabilitation institute (ckri) propose to recruit a convenience sample of individuals who were hospitalized with covid-19 to evaluate the efficacy of administering the compass course to a novel population, to improve psychological well-being, engagement in everyday activities, and purpose in life. a focus group will be scheduled 2 months after the completion of the compass course. this session is composed of brief questionnaires and designed to obtain post-course data to help evaluate the compass course intervention.

aim #1: to evaluate the acceptability of the cc intervention (purpose renewal intervention) delivered via hipaa-compliant zoom to adults with psc who report lacking a sense of direction in life. quantitative measures of acceptability will include number of inquiries to explore study participation; participant intervention completion rate; participant responses to an experience survey at posttest. the investigators will also conduct posttest focus groups to assess aspects of the intervention that may need to be modified prior to a larger study. aim #2: to determine the extent to which the cc has beneficial effects on psychosocial outcomes (i.e., self-reported purpose in life; functioning; persistent concussion symptoms) for adults with psc. the investigators will use a one-group, pretest-posttest design collecting pretest, posttest, and 2-month follow-up data. main outcomes will include self-reported purpose in life (purpose in life subscale of the scales of psychological wellbeing (ryff \& keyes, 1995) and meaning in life questionnaire (steger et al., 2006). secondary outcomes will include engagement in purpose activities (life engagement test \[scheier et al., 2006\]) and concussion symptoms (rivermead post concussion symptoms questionnaire \[king et al., 1995\]. aim #3: to explore the relationship between participants' real-time responses to purpose prompts delivered via a smartphone app and intervention adherence and outcomes. the investigators will employ mobile ecological momentary assessment to prompt participants to make daily purpose-related choices from the start of the study intervention and evaluate whether participation in these daily prompts is related to primary and secondary outcomes.

Eligibility criteria:
inclusion criteria: * response to purpose status question (psq) suggests that lack of purpose direction * 18 years or older * able to communicate in english * evidence of persistent concussion symptoms (concussion symptoms that persist at least 3 months after date of concussion) for concussions occurring in the past 2 years * received medical-rehabilitative services for persistent concussion symptoms over the past 12 months based on documentation in epic (i.e., icd9 or icd10 codes) or clinician referral to the study * access to computer or tablet and adequate internet connection to participate in video conference * has an email address * has a device (computer with webcam, tablet) to use for zoom access during sessions * has access to an internet connection - broadband wired or wireless (3g or 4g/lte) * own a smartphone with one of the following operating system versions: ios 9.0 - 9.3, 10.0 - 10.3, 12, 13.3, 13.7, 14.0 - 14.4 or later android 8.0 - 8.1.0, 9, 10, 11 or later * agrees to use personal smartphone to download mema application and respond to application notifications (mema is described below) * agrees to make every effort to attend all group sessions, respond to mema notifications many times per week, and to spend 30 minutes each week performing homework exclusion criteria: * has significant problems in everyday functioning that would interfere with full participation in the intervention, indicated by a wsas score above 30 during screening (indicative of severe functional pathology \[mundt et al., 2002\]). * reports being unable to see, hear, or speak (with or without assistive devices)